Apexification

Apexification and method of doing

1. Hawler Medical University College of Dentistry 4 th Stage Group C Pedodontic lecture Apexification

2. Contents Definition Steps of the technique

3. Apexification Definition: Is a method of inducing a calcified barrier at the apex of a non-vital tooth with incomplete root formation.

4. Apexification

5. Apexification Effective in the management of immature, necrotic permanent teeth. Irreversibly diseased pulps and open apices. Should precede conventional root canal therapy.

6. Apexification The procedure has been demonstrated to be successful in repeated clinical trials stimulating the process of root end development, which was interrupted by pulpal necrosis, so that it continues to the point of apical closure. When the calcific “plug” is observed in the apical portion ,routine endodontic procedures may be completed.

7. Steps of the technique 1-The affected tooth is carefully isolated with a rubber dam, and an access opening is made into the pulp chamber.

8. Steps of the technique 2. A file is placed in the root canal, and a radiograph is made to establish the root length accurately. It is important to avoid placing the instrument through the apex, which might injure the epithelial diaphragm.

9. Steps of the technique 3. After the remnants of the pulp have been removed using barbed broaches and files, the canal is flooded with hydrogen peroxide to aid in the removal of debris. The canal is then irrigated with sodium hypochlorite and saline .

10. Steps of the technique 4. The canal is dried with large paper points and loose cotton.

11. Steps of the technique Using Calcium Hydroxide Using mineral trioxide aggregate (MTA)

12. Steps of the technique 5. A thick paste of calcium hydroxide is transferred to the canal. An endodontic plugger may be used to push the material to the apical end, but excess material should not be forced beyond the apex. Using Calcium Hydroxide

13. Steps of the technique 6. A cotton pledget is placed over the calcium hydroxide, and the seal is completed with a layer of reinforced zinc oxide–eugenol cement.

14. One month after initial treatment

15. Six months after initial treatment, a definite calcified stop was encountered when the file was introduced

16. General rule, the treatment paste is allowed to remain for 6 months. The root canal is then reopened to determine whether the tooth is ready for a conventional gutta-percha filling. Frank has described four successful results of apexification Treatment : (1) continued closure of the canal and apex to a normal appearance, (2) a dome-shaped apical closure with the canal retaining a blunderbuss appearance, (3) no apparent radiographic change but a positive stop in the apical area, and (4) a positive stop and radiographic evidence of a barrier coronal to the anatomic apex of the tooth.

17. Five months after the placement of the gutta-percha canal filling.

18. If apical closure has not occurred in 6 months, the root canal is retreated with the calcium hydroxide paste. If weeping in the canal was not controlled before the canal was filled, retreatment is recommended 2 or 3 months after the first treatment.

19. A 6-month postoperative radiograph. A tube and resin core was placed, and the tooth was restored with a jacket crown. Currently, an aesthetic bonded composite resin restoration would probably be the preferred interim restoration until the patient has attained adulthood.

20. Steps of the technique 1-The canal has been opened, rinsed with 5% sodium hypochlorite , dried, and Calcium hydroxide was then placed in the canal for 1 week. Using MTA

21. Using MTA 7 days after initial treatment with calcium hydroxide, the incisor was instrumented to remove calcium hydroxide and all the remaining tissue before further treatment.

22. The apical 4 to 5 mm of the incisor root has been filled with mineral trioxide aggregate (MTA) . A moist cotton wool pledget was then placed in the canal overnight and the system temporarily sealed using thermoplasticized gutta-percha using Obtura II, and a zinc oxide/ eugenol dressing. check radiograph was obtained to evaluate the apical seal. Using MTA

23. The gutta-percha and cotton wool pledget was removed the following day and a definitive root-filling placed coronal to the MTA using thermoplasticized gutta-percha. Using MTA

24. Te incisor has completed initial treatment with MTA. A temporary restoration has been placed to seal the canal opening . h Using MTA

25. At the 6-month and 1-year follow-ups , the clinical and radiographic appearance of the teeth showed resolution of the periapical lesions.

26. Tooth treated by the apexification method are susceptible to fracture because of the brittleness that results from non-vitality and from the relatively thin dentinal walls of the roots. The calcium hydroxide apexification technique is the duration of therapy, which often lasts many months. Using MTA

27. Ararat Mountain/ Northern KUR DIS TAN